TOPICS Dr. Tapia writes about

“Sorry, I Ain’t Sorry”

At first listen, Beyonce’s Lemonade album seems to purely be about her, and her relationship with herself and her husband. However, as I’ve had it literally on replay for the last week in the midst of facing a major Professional decision, I can’t help but feel it’s so much more for women. For me, it can help me find the confidence, self-love and inner strength to know that I really don’t need a man, or an organization run by men, to be successful and to do what only I can do.

I am still in the midst of the decision. Do I accept an employed job as the only Geriatrician in an entire hospital system run on a fundamentally corrupt physician payment model and subsequently poor patient care model just for the salary? Or, do I do what I know will make me most happy and opt-out of Medicare and start my own practice doing medicine my way (the right way……where I spend time with patients and families, listen, counsel, diagnose, and walk with) despite the likely low financial return? If anyone’s reading this, they’re probably thinking, “This seems obvious…….do what will make you happy, go for option number 2.” I wish it were that simple.

I am a female caregiver through and through. I became a wife and mother right as I became a physician. I am terrible at putting myself first, even when it’s essential. Part of taking care of oneself is knowing how to and when to avoid abusive relationships. It’s from learning from our past mistakes. Whether it’s with spouses, friends, employers, businesses, or any type of relationship, knowing one’s strengths and failings is crucial. Often it takes making the mistakes first to learn our own strengths and weaknesses.

My strengths are these. I’m smart, and also extremely caring. I empathize truly and deeply. I do feel the pain of my patients and their families, and the joys too. I’ve been a patient also, so I don’t have to work too hard to put myself in the shoes of my patients. I’m honest and transparent. Authentic perhaps? I can’t lie, nor can I fake things. This leads me to my weaknesses: I am incapable of being “political”. If I see something that isn’t right, I can’t keep my mouth shut to save-face for someone else. When I try, I become testy. I don’t suffer foolishness among colleagues well at all. I will fight for my patients and doing what is right for them at all costs…….usually at the cost of reimbursements from Medicare. I am intensely bothered by the difference in how female physicians (myself included) and male physicians are treated by those we care for, work with and among, and are employed by. And I am unlikely to get over that.

Where is this exercise going and why is Beyonce’s “Sorry” the current song-de-jour on repeat? Despite the above, I still have this nagging voice telling me I should take the job with the hospital system. It’s the voice of fear, of feeling bad for saying no to them, of repeated patterns of delving into a relationship for security and not for what is right for me, and of the problematic thinking on my part that constant self-sacrifice is a good thing. Here is what I know. The job will not make me happy. It would allow me to stay in Medicare, but in a very toxic practice environment. It won’t afford me the flexibility I want to be the best mom and doctor I can be. I know I’m unlikely to last in that environment as I can’t keep my mouth shut about things that are wrong but I also don’t like pissing off all my colleagues. I don’t like that kind of competition. For a geriatrician, opting out of medicare is such a huge deal. Telling my future patients that I won’t take their free insurance (because Medicare is a narcissistic regulator of physicians) is scary, even when it allows me to give them better quality of care.

So, I have been gearing myself up for the moment when I finally make the right choice for me. This hospital system has been literally leading me on for months now. They are apparently finally going to show me the proposed contract and letter of intent soon. And I want to be ready to do what is right for me. I don’t want to close any doors prematurely, so I’m waiting to see the contract before I do anything definitive. However, based on their behavior thus far (poor communication, asking me to wait on them without any guarantees or retainers, clear resistance from other physicians I’d be working with), I have no reason to believe that this is a group or organization I want to be part of, particularly when I’d be one of the only female physicians doing what they’re asking me to do. Just like people, organizations don’t change unless they see the need for it and seek it out themselves. Medicare and many of the businesses of healthcare are indeed narcissistic. While many good people work for and within them, the overall company culture is one that is incapable of empathizing with those who work for it while simultaneously being hyper-sensitive and reactionary due to a fragile sense of self (or lack of any true mission beyond money making). These are the kind of relationships that are so trying.

I don’t know if I’m ready yet. However, it’s not a matter of if, just when. And when I finally am ready, I will serenade Medicare with Beyonce’s words, “Sorry, I ain’t sorry…….middle fingers up, put em hands hi. Wave em in his face, tell him boy bye……I don’t feel bad about it, it’s exactly what you get, stop interrupting my grinding.” Instead of a boy, it’s Medicare in my mind, and the health systems. And my “grinding” is my doctoring. Because I am one bad-ass physician, and just about every patient I’ve ever had will tell you that. Medicare, regulators, politics and those who just care more about the Benjamins have been interrupting my doctoring…..and I’m sick of it. And I ain’t sorry when I finally leave them.